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1402 Embracing a biopsychosocial approach to type 2 SLE: insights from the type 2 SLE consortium
  1. Jennifer L Rogers,
  2. Megan EB Clowse and
  3. Amanda M Eudy
  1. Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, USA

Abstract

Background Patients with SLE experience distressing fibromyalgia-like symptoms of fatigue, widespread pain, mood disturbance, and brain fog that negatively impact quality of life and are challenging to manage. These symptoms, termed Type 2 SLE, can be related to inflammatory and non-inflammatory etiologies. Studies of fibromyalgia suggest that addressing biopsychosocial factors can improve quality of life. A Type 2 SLE Consortium was created to bring together a multidisciplinary team of patients and clinicians to develop equitable, feasible, and potentially effective approaches to care for people living with Type 2 SLE.

Methods The Type 2 SLE Consortium included patients meeting ACR/SLICC SLE classification criteria and clinicians who treat chronic pain, insomnia, and mood disorders. The consortium met in 3 group sessions; additionally, each consortium member was invited to complete an individual interview. The sessions were conducted virtually between August 2022- April 2023 and auto-recorded and then transcribed.

Early sessions included a review of the Type 1 & 2 SLE Model, followed by suggestions from Consortium members about the possible etiology, contributing factors, and treatment approaches for fibromyalgia-like symptoms. Rapid qualitative evaluation identified key themes.

Results The Type 2 SLE Consortium included 2 women with SLE (both Black with SLE duration >15 years) and 18 health professionals (67% female, 89% academic). Expertise was gathered from adult and pediatric rheumatology, integrative medicine, neurology, psychiatry, psychology, palliative care, neuropsychology, medical weight management, physical therapy, social work, sleep, pain, and stress management. The majority (83%) attended at least 1 group meeting and all, but 1 member completed the individual session.

The consortium identified a range of biopsychosocial factors that can predispose, precipitate, and perpetuate Type 2 symptoms such as fear, stress, and trauma (figure 1). Two main categories of approaches to care were identified: one for providers and the other for patients (table 1). Key themes consisted of building better therapeutic relationships, adjusting expectations, improving symptom understanding, lifestyle interventions, and multidisciplinary collaboration. Specific guidance for clinicians included active listening, validating symptoms, and using motivational interviewing. Pharmacologic therapy was discussed less often; with the exception of treating mood disorders and minimizing the use of narcotics, benzodiazepines and sleep medication. Patients with SLE would benefit from setting personal goals, building self- efficacy, pacing, identifying personal factors, and reframing their relationship with symptoms.

The importance of incorporating cost-effective and culturally sensitive resources was highlighted throughout the consortium.

Conclusion Key recommendations from this multi-disciplinary Type 2 SLE Consortium were to individualize treatment based on the biopsychosocial underpinnings driving a patient’s symptom burden. The importance of communication, trust, education, and multidisciplinary collaboration was emphasized. Rheumatologists cannot be the sole providers to manage Type 2 SLE symptoms but can encourage patients to partner with others who can provide the necessary care. Our future studies will continue to develop and evaluate holistic approaches to SLE care.

Abstract 1402 Figure 1

Biopsychosocial factors that contribute to Type 2 SLE symptoms in SLE

Abstract 1402 Table 1

Care delivery and treatment recommendations for clinicians and patients

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